Strong Is Ageless: How to Age with Power, Strength & Science with Dr. Vonda Wright

On this episode of the Resetter podcast, I bring you Dr. Vanda Wright and we are going to talk about menopause and the musculoskeletal system. And it's a really cool conversation for a variety of reasons, but one of them is you're going to want to get a pen and a pad of paper because has she got some incredible ways that we can keep our musculoskeletal system strong, healthy and functioning well into our hundreds. So let's talk about who Dr. Wright is. So she is an orthopedic surgeon. She has worked with a lot of elite sports teams. This isn't her first book. She actually has a book coming out. She's done several books and she has literally been in the trenches with athletes, non-athletes, women, men for years. And what I love about Dr. Wright and why I wanted to bring her to you is she now has mastered a formula for musculoskeletal health and menopause. So what you're going to learn in this conversation is you're going to learn that when estrogen goes down, this is the beginning of things like injuries from our activities, joint replacement osteoporosis. And there are some really simple ways that we can start to prevent this. And it doesn't matter if you're 70 and hearing this or you're 30 and hearing it. She has some really smart strategies for making sure that we prevent osteoporosis. We prevent hip replacement and that we stop injuring ourselves. So we go through that. We also spent a lot of time talking about nutrition and what do we need to know about the way we eat for our musculoskeletal system? We broke down every single exercise you could think of. We went from Pilates to yoga to rocking to weightlifting to how often should you be weightlifting to what kind of muscles are you trying to activate when you weightlift? So a lot of times when I bring you all podcasts, there's a lot of theories and philosophies and mindset. This one is application. And I'm really excited to bring it to you. She has a new book coming out called Unbreakable. We will leave links for it. I highly recommend that you grab a copy and sit back and enjoy her humor, her straightforwardness. I absolutely loved. And it's just a really profound and fun discussion that I know is going to help you move your health forward and give you a new vision of what fitness can look like as we age. So Dr. Vanda Wright and Unbreakable, enjoy. Welcome to the Resetter podcast. This podcast is all about empowering you to believe in yourself again. If you have a passion for learning, if you're looking to be in control of your health and take your power back, this is the podcast for you. I am just so excited to have this conversation with you. So welcome. Thank you. And you know what I have to tell you? I have so many of the digital world. I feel like I've known you for years. So I'm finally so happy to sit across the desk from you. Yeah. Thank you. I have to tell you that I think the menopausal conversation has been really interesting to watch how it has transpired. And I always say we went from a cultural hush to cultural chaos. And then somewhere along this like emergence, I saw your work and I was like, yes, well, let's talk about the musculoskeletal system and how it changed because not only did I have major injuries as an athlete going through my menopausal experience, but I had a practice full of menopausal women that I didn't really understand what was going on until people like you really emerged and taught us. So thank you. I'm so happy you wrote this book. My pleasure. My pleasure. Yeah. Okay. So here's the first heart space. What I want to know is what is it like to be a female orthopedic surgeon? Let's just start off with that. Oh my God. So you know, we're the fun people in medicine, right? Everybody going to all the guys going to orthopedic surgery, 94% are guys. Now when I trained so, so long ago, there were 3%. So between, you know, then and now we've doubled, which means it's going to take us 150 years to have a... God, I better take some... I better put it fast a little more. We're trying really hard, but so 94% guys and we're the fun guys, right? Because we're all the old athletes, we're, they're the engineers, but even they're fun engineers and we get to do fun things by and large except for this musculoskeletal oncologists and some of the pediatric stuff. Most of what we do is fun and aspirational. Imagine I have spent my life making people walk again. Yes, right? Or making their shoulders again. Yes. Well, every time one of my golfers that I fix his shoulder does a hole in one. I'm like, you know, that's mine. I did that. So it's really aspirational. It's beautiful. But what an honor, you know, I mean, for, for, for doctors, it's such an honor. People trust us with a lot of important things. Sometimes the first time they meet us. And that's a, that's an honor. That's sacred. And so, yeah. So we're the fun people, but we take what we do so seriously. Like you can imagine academic meetings. There are these big debates on where the two millimeters we put the ACL screw. I'm like, you're from an outsider. You're like, it's two millimeters. Right. But it's really. Wow. Wow. So were you in practice and, and doing surgeries on both men and women and then seeing like a trend in menopausal women? Is it like, I would think, you know, my, my husband just had hip replacement surgery. And I was like, I was like, did anybody take a picture of his hip? Like exactly. I would have been in there watching if they would have let me watch because I wanted to like see how where it had degenerated and all that. So I would think if you had the opportunity to open up a lot of menopausal women's hips and shoulders that you saw something most of us didn't see. So my practice, just to answer the first question and then tell you how I got into where I am now is, you know, I'm a fellowship trained sports doctor. So my job is not only the sports surgery, but I'm a team doctor. So meaning that I'm the guy on the field and all the football. I was the head football doctor for University of Pittsburgh and all their Olympic sports teams. And so there's the team doctor side of that. And the reality is most of the teams I took care of were men's athletics. I had a few female teams, rugby teams, but just the way it worked out. But in 2012, Mindy, I read a statistic that women make 80% of all the healthcare decisions in this country for themselves and everyone we touch. And it just a light bulb went off because we're 51% of the population and therefore 50% of all my patients, athlete or not, were women. And so when I went through my own menopause more than a decade ago, it hit me. I tell the story, 40, best shape of my life. I had a baby. I'm training for all kinds of things. I've got God knows I'll never get back to it. 19% body fat. And then 47 about killed me. Right? And I became a scholar, not only of women, but of menopause and really it's such a deep dive. I consider myself an expert, especially within the lane of musculoskeletal. Because here's what women would say to me once I started listening with menopausal ears. I'm sure you've heard this in your own practice. I don't know what happened. Yep. I think I'm falling apart. Yep. Yep. Do you know what else? I'm really going crazy because I talked to my other doctor about it and they said, nothing's wrong with you. You're just getting old. Yep. This is the part that killed me. And this is what really keeps me so focused. They say to me without prompting, but you know what? I didn't want to come in today because I have a very high pain tolerance. Like it's a button, right? Yep. High pain tolerance. But doc, I just can't take it anymore. In a very defeated way. And I'm a musculoskeletal doctor, but people are weeping because it's so hard. So I decided once I started listening with those ears, the ears that come with experiencing it, even in an academic, right? It's more than reading it in an oyster study. I lived it. And musculoskeletal syndrome and menopausal is one of my biggest symptoms, right? I couldn't get out of bed. So painful. Wow. And we can talk about all those things. That is when I really became committed to exposing what affects 80% of all women at almost the same rate as hot flashes, night sweats and brain fog is the musculoskeletal syndrome of menopause. Yep. Yep. Yeah. And so let's launch from there. As women are listening to this, I feel like there's some like golden rules we need to follow when we go into our perimenopausal years. Like are there things that we should start doing differently? I can tell you for me, I was an ex-tennis player in college and I turned me into a runner and all of a sudden at 43, I was injury upon injury upon injury. And it took me several years to figure out, oh wait, something has shifted as my hormones have shifted. And so I had to change the way I worked out. So what are some of those ground rules that we need to know when you're going into menopause as far as your musculoskeletal system goes? Well I think it's helpful to know that muscle, tendon, ligament, bone, fat, satellite stem cells, cartilage, disc, annulus in the back, they are all from the same stem cell. So they're all going to respond in a cousin-like way to estrogen. Every one of those tissues has estrogen, alpha and beta receptors on them that keep them healthy. Cartilage, for instance, the matrix is like a mesh, if you will, with estrogen receptors and without estrogen sitting there, the matrix starts to fall apart. And here's men before 50 have more arthritis. Women after 50 without estrogen have rapid increase in arthritis in the hips, the knees, the hands. So the first thing women have to know going through what I call, I call this thing, I like to make up words. So I call this transition the metalescence. To be reminiscence, yeah, to be reminiscence of the chaos of adolescence. Like people get that, right? Oh, that's good. Yeah, metalescence is awesome. We're exiting our hormones the way we came into them and total chaos. Number one thing to go into is to recognize this is different, right? The same things are not going to work now that worked then. This is a different life stage to embrace. So in every tissue in the musculoskeletal system, so it follows that, for instance, if your tendons and ligaments naturally was age, increase, these are supposed to be collagen fibers, increase your covalent bonding and get tighter, and then they don't have estrogen to help repair the micro-tears, we're going to have more tendonitis. On top of the fact that estrogen is a huge anti-inflammatory, it works directly on the immune system, it modulates immune cytokines, we're more inflamed, so the microenvironment is hot and bothered, we have less regenerative capacity, and just the natural aging, we're getting tighter. So we're more prone to things like tennis elbow, Achilles tendonitis. So just recognizing, oh my God, it's not the same, I can't just rest for two days, I have to have a mobility practice to stretch out my tendons and ligaments, to keep my joints moving so the synovial fluid continues to be produced and you don't dry up like a raisin in the sun, right? So recognition. What age do you think that starts at? Yeah, you know what? Perimenopause on average in this country is about 45, however, it can be much earlier, it can be 35, right? And it all comes down to, and your listeners know this, to the fact that by about age 40, we have 1 to 3% of our eggs left, right? So it's not producing enough estrogen. And by the time it catches up, or people recognize that they're about 45, with complete cessation of our menstruation on average in this country, about 52. Right. But I call the decade between 35 and 45 the critical decade to get your shit together. Here's why. Here's why, because I wish I had done it. Yeah, me too, me too. Because you don't know about you, you were an athlete, I was an athlete. If I saw I was gaining a little weight or I was sore, it was a really quick fix for me. Yep. And I'm, you know what? This is so ironic. I am a musculoskeletal aging researcher. I don't think I thought it would ever happen to me. Oh yeah, that's interesting. But if you're listening, please recognize that between 35 and 45, 35, you still have all your hormones by and large. You've got this youthful vigor. 45, you're going to start to be chaotically perimenopause when things change. Let's make sure we have learned what's coming. Let's make sure we establish a standard of our nutrition, right? Because when we get to 45 or even later, 52 when menopause happens, if we're suddenly having to create six or seven new lifestyle things, it is so weird. People are like, what should I do now, Vonda? And if they're 55, I'm like this and this and this. Right. Right. But at 35, if we layer in, how are we going to have an anti-inflammatory diet? How are we going to eat enough protein? And what does that even mean? If we think about, okay, at 35, how do I start lifting in a way that's going to help me stimulate muscle protein synthesis and not just hold endurance? Right. I think starting early and layering on the lifestyles, by the time we get to be perimenopausal, when hormones may or may not be helping us at all, our endogenous hormones, it's not such a shock. It's not so hard. Yeah. So that was a lot. Yeah. No, I really like getting ahead of it. I think that is a really important point. And it was interesting as you were talking, I was thinking, yeah, when I was 43, that's how I found fasting because I, like you, anytime I needed to drop a few pounds, I would just put a couple more hours in each week on the, you know, running and it would make you go, yeah, run a little more, but then the injury kept piling upon injury, upon injury. And I was like, what is going on? And so that's when I learned about fasting. I was like, oh, wait, I can actually get my weight to drop doing it that way. Yeah. What's interesting about what you're saying is that you're using nutrition like most people would use supplements or they would use medication. Like I love this idea of like bringing it in in the beginning so that you can keep that a good foundation of inflammation down. And then my question is collagen, is it, would it be worth it to, to eat collagen rich foods, especially in those early, early perimenopausal years? Well, I think the best date on collagen, and I'm not an expert, but I think the best date on collagen happens to be surrounding bones and muscle actually. Oh, okay. Yeah. Okay. And so, you know, there's some data that you can increase bone density one to 2% a year by supplementing with the right kind of collagen. And then entering the critical decade, maxed out on everything with the best bone density, right? Before you start losing your estrogen with the best muscle. And so pulling in all the tools, I don't think it's one thing. I think if I look at the, and I'm, I mean, we're both deep into the longevity community. We both appear at these same things. And I think what happens sometimes is we think one gadget's going to do it for us. Right. And that's not my experience as a clinician. No. It is this constant, it's this ecosystem, as we like to say, it's not one little thing you turn on with the switch. Well, that's why I talk about it like this. Yeah. You know, I was doing, at all the biohacking and everything for so many years. And one day it hit me, I don't think you can hack a woman's body. You can't like hack into it. You have to harmonize it. It's not a body that's hackable. And it's a body that needs love and nourishment and needs a rhythm to it. And so I really think- You work in a rhythmic way. When you think about it every month, there's a rhythm of our complexity hormones up, hormones down. We exchange different verses. You know, men get their testosterone in it, slowly declines. And so you may be more inclined to hack that. Right. That's another topic. It's another topic. You know, I've made several comments, I really do love men. I marry men. I have forced men. Of course. Yeah, right. There you go. Let's be. Yeah. Well, it's our moment too. We're having our moment. We're finally getting to stand on our soapbox and scream from the rooftop. So, okay. So we've got nutrition. You're going to make some nutrition changes. Okay. What else could I do as I'm going through this transition? So in the critical decade, please, please, please, please use Pilates and yoga as your movement. I sing, but your meat and potatoes has to be building muscle mass. Yeah. Yeah. While you still have your estrogen, I say, do it while you have estrogen. Do it while you, you can do it later. You sure can. And I'm working my butt off to try and I know you are too. Yeah. Your endogenous estrogen is easier to make muscle with. This is stimulus. So learn to lift. You don't have to lift heavy when you're 30. You should, it depends what you want. If we want to go into prescription of lifting, people criticize me a lot because I mostly talk about heavy lifting. I don't care how you lift, but it depends why you're lifting. So if you're younger and you want to build endurance, then lift for endurance. Do tons of reps with the lightest weight possible to 25 to failure. I would never do that. How boring is that? But anyway, that's a lot of joint motion. That's a lot of joint. If you want hypertrophy, which is what people in their 30s and or generally want, well, that's a mid-range reps set. As a solidly post-menopausal woman like me, I am lifting for strength and power, which requires heavier lifts. So in the younger years, which is what you've asked me about, let's build a foundation. So our point knows how to lift. Let's use hypertrophy. So you know the form so that as you progress and need that strategic stress of lifting heavier, you don't have to start at zero off the couch because that's a long. Yes. Yes. Yeah, I would definitely say I fell in the camp in the 40s because I loved to run. I fell in and I love yoga. So I fell in that camp. And when I went to go lift weights, when I lifted weights in my 20s in college because we had to, it was like I could look at a barbell and I got like muscle. Now I'm like two years ago, I'm 55. Two years ago, I went into the, I hired a trainer. I was like, I need to build muscle. Oh my God, we were working so hard for so many months and then I would look in the mirror and I'm like, it feels like I'm doing nothing. So yeah, so I think you're really onto something. If you don't, if you, if you, you would say 40s, late 30s, like switch away from your cardio and really look at weightlifting. Is that what you're saying is like the critical time period? I think cardio is important. They do two separate things, right? We want a big, we want a strong cardiovascular engine. Listen, disease kills is the number one killer of men and women. I'm not seeing abandoned cardio. What I am saying though is it cannot be the only thing you do. I'll tell you from an orthopedic doctor standpoint and I'm sorry, runners, when I say this and I was a runner, I've run multiple. I get it. We get, I, if I hear one more runner telling me they don't lift with their legs because they run. Oh God. That is a surefire way to end up in my clinic with some kind of butt pain because your glutes don't fire or because you've got pelvic instability and instead of running in a straight line, you're running like a weeble, right? Are you, running as a single leg sport, you have to be able to balance in a, in a, in a mini squat without falling over to run well. Otherwise you're adjusting all the time. So when I, so when I say cardio is important, but if we're looking at it from a health span and longevity, I want you to, this is just how I prescribe it. There's many ways to do it unless you're training for a big race, unless you're a training athlete again, running in marathon, 80% of the time send, spend in base training. So we build mitochondrial flexibility. We're burning fat. We're at our lactate threshold. 20% of the time, and I'll tell you, this is not based on my research. It's based on, there's a researcher here in my building that trains tour de France. Oh, yeah. Oh wow. 80% of the time base training, 20% of the time we are gunning it as fast as it's safe for our heart. So that we get, so that we give our bodies that positive stress, working in that high zone to stimulate all the, all the muscle protein synthesis and cardiac function. But we don't do that all the time. And that's what I see. The injured people coming into my office spend a lot of time at the highest, highest zones. Yep. And they're injured every three weeks, and then they have to recover, and then their brain's angry, no dopamine. So I'm not saying cardiac's not important. It's not the only thing anymore. But and what I hear you saying is, and if you're going to do it, do some sprints, get the max cardiovascular, and then get your butt to the gym and start lifting weights. Yeah. Yeah. So with lifting weights, what are you a fan of like max amount of weight for eight reps or is there like, and is there like a formula you follow? So when we're lifting for strength and power, the strength, and again, I'm about to, I'm framing what I'm saying, because now I can say, no, let it go, let it out, let it out. Yeah. Of all the bros hopping out of the woodwork and telling me that, that I don't know what I'm talking about because, but listen, I've been, I've been in the locker rooms of the best athletes training with their trainers, writing my own things, reading, I know what I'm talking about. So I'm just, I'm just responding in my own head this internal. Of course, I love it. I'm watching what you're doing. I think it's beautiful. So listen, I prescribe powerlifting, upper body push, upper body pull, lower body push and pull for the four power lifts. So bench press, some kind of pull, deadlift and squat. Those are the lifts that I want you to lift to failure, but to get to failure in a lift range of three to six. Now, oh, nice. I've been, I've been taking care of people so long that I know for sure they want to be, they want a specific instruction. So I have chosen four. It's what I do. It's what my strength conditioning coach taught me to do. Four reps to failure. So what does that mean? I can pound out four reps. I can, if I bench pressing, I can do five like this, but if I try six, one arm's coming down and I'm dumping the weights off, right? Four reps, four sets for each of the power lifts. Now that's not the whole story, but power lifts are complex. They do multiple joints. They involve your core, everything, right? To support that lift, I then on bench day will do the supportive lifts, biceps, triceps, lats, delts, eight to 10 reps. I'm not trying to, I love that until I, yeah. So that is the framework that, that I use for midlife women plus the core. So that basic framework builds strength. Okay. When, how many days a week are we talking? Cause you're doing the main muscles. Of two, I'd love people to carve out four days, but two. And what would it, would it look like two days of the power lifting and two days of the supportive lifting? No. So it's one power lift a day. If you're doing four days a week, one power lift a day and the supportive lifts to go. And there's some overlap. For instance, on a dead lifts, dead lift supports might be some plyometrics, might be some steps, not step ups with a weight, might be some goblets, glats, might be some hamstrings. And for muscles love varieties. So it's, it's usually not the same thing for six weeks or so, but, but it's, so that's how I do strength. Now when you, that may take six months to build up through from nothing. It may take nine months to get this form down. I had to expect nobody to go from couch to heavy lifting. It's a progression. But once we're solid in that, once we've been doing it for a while, if we want power, which is strength over time, then we add in some tempo lifting, meaning I hate this when my strength guy makes me do it. One, two, three down. Oh yeah, I hate that. I'm like, this is torture. But that's going to get me off the floor when I'm on the floor. That power is going to keep me sane. Right. Cause we lose our type two muscle fibers with age. And so building power, the plyometric type things, that's what that's all for, not to torture us. Well, you also bring up a really good point and something that my athletic brain had to think about in my forties is that the purpose of working out became very different. And right, like I, like you mentioned dopamine earlier, like the, the pushing myself out of breath gave me the dopamine high. And I started not running as much cause I kept getting injured. And so then all of a sudden I had to call it forward movement exercise because I thought if I called it, if I called it walking, I was criticizing myself. I was like, are you seriously walking? And then the other part of my brain was like, no, I'm moving forward. It's a forward movement exercise. But then I realized that right, left, right, left movement was really calming to the nervous system. So all of a sudden forward movement became my like, you know, Xanax. And so I really repadnered everything, but strength training. What's interesting about strength training for most, not maybe in your forties, but if you start, if you're listening to this and you're in your fifties, you're 55, it's not like you're going to do all this heavy lifting and look in the mirror and have bulging muscles. You're going to have security as you continue. Maybe you will, but it does, for me, I've noticed it doesn't have the same visual effect. But where I notice it is when I'm standing in line, and all of a sudden my posture feels better, or you brought up the point, I reached down to pick something off the ground and I'm like, oh, wow, I'm going to pop back up. So can you talk a little bit about what we could expect if we follow a strength training protocol that might be as satisfying as looking in the mirror and seeing a muscle? Well, so here's what happens. The only people who pop out muscles like you're thinking are, I mean, some, some people are genetically that way. You may work out forever. And it's just part of your cytoplasm. People with very low body fat, right, will expose their muscles, right? You may have, look at discus throwers or shot put throwers. Those are really muscular people, but they also have a lot of body fat. So they don't, you don't see the definition. But what you will feel if you're a midlife woman, is your clothes will fit better. Leaner profile, because, you know, you'll, you'll burn some of the visceral fat. And I, I wrongly say, but I just for ease, I say we're exchanging fat for muscle. But leaner, when we get on a composition, we're leaner, makes our clothes fit better. Cause I say muscle is nature's spanks. Hmm. That's beautiful. It really goes away a little bit. And so those are still satisfying, right? Yes. Great. If I want to be really cut and lean, that is hard bodybuilder work. You got to build by eating more calories to build the muscle. And then you don't look like you're lean at all. And then you got to suck all that off. And unless you're trying to do that. Yep. What's the goal? I always return to what are we working for? Right. I am working for strength and power along the way. My clothes fit better. I'm, I'm leaner. I'm not quite as jiggly. I don't have to wear spanks, right? So not that I don't like Sarah Blakely. I sure do. I was going to say, you know, hopefully Sarah's not listening. I'm going to be interviewed, Sarah. I'm just trying to build some muscle. Yeah. Yeah. So you bring up a really important point because when I was in my 20, I think most of us, when we were in our 20s and 30s, use cardio to get the same effect. You're saying, Hey, when you go into menopause, use weight lifting to get the same effect you were trying to get in cardio in your 20s and 30s. Is that, is that accurate? And the fact of the matter is that you can have a big cardio engine. And still not be strong in old age. Can't still get a pickle jar. Right. Maybe a lifelong runner and still become frail. Cause you can't get up out of a chair because running doesn't build the same kind of muscle that lifting does in the lower body. No. And what about grip strength? You know, we have all these studies on how grip strength is a predictor of longevity. Yeah. And what I've noticed in the weight lifting was that you're there's, you have to hold the bar. You have to pull yourself up. Like there's a natural increase in your hand strength. And that has to be beneficial. Do we, what do we know about grip strength and, and its purpose through menopause? Yeah. You know what there's a, and those studies are population studies. They're not done in, it's not particularly in women per se. But what it showed is people who have a better grip strength, I think the number in women is over 30 pounds of grip strength. Men over 50, I believe, if I'm remembering my numbers well, it just infers better overall strength. It's not saying that you can bench a certain amount of pounds. It just means in general you have upper body strength, which is always less than lower than strength. But remember those are in populations. Those are population studies. What do we know about our population in the new age? What about our population in the United States at least 70% of people do no form of organized exercise at any time. So I think it's a predictor of longevity and frailty. Kind of a party trick. If you ask me, I wouldn't be satisfied. I have a grip strength of whatever over 35. That's not the end all be all. It doesn't mean I can stop working. Right. So I shouldn't buy one of those grip strength or like 20s. And I show people, I'm like, let's see what you can do. It's an awareness. Because if you've got a grip strength of 20 and you think you're okay, you're not. Yeah. Okay. So we've got nutrition. We've got strength training. And I think we've said it, but I'm curious if you strongly feel we should stop the long distance running, the Spartan racing, the cross fitting, like is all of that off the table as we go through this? No, I don't think I am not the orthopedic surgeon that is ever going to tell you to stop running because it's going to give you arthritis. Number one, there's no data, no data at all. I am never going to stop you from wanting to achieve a goal. I do Spartan races. I mean, I still, I mean, one of my, my first Spartan race was several years ago at that time as 56. And someone actually said that I was giving a speech. And as I walked on the introducers like, and she ran her first Spartan race at 56. And I started thinking, what does that have to do with it? I am, right. I am capable. I believe that I'm going to try it and not die. So no, I am not saying, but what I'm saying is you need to train differently. And you need to harness the wisdom of your age, not to be a jackass out there and just think that because you were 20 and could do it, you can do it now, right? Unless you've been training for that, keeping your tendons and ligaments springy, building muscle mass, feeding your body, don't expect it to respond like it did the morning you woke up from parting the night before and you ran a race. That doesn't happen at our age. No, right? So yeah. And what about rocking? Rucking is making quite the, I'm sure you're getting asked this all the time. And I'll, I'll tell you my behind the scenes. I watched all the rocking and I watched all the women that were rocking. And I, the first thing I thought is, are you fucking kidding me? I can't just go for a run. I can't just go for a hike. Now I kind of put a goddamn weighted vest on. Like I was like, I'm rebelling against this. You are. And then I put, and then I put one on. Oh, you loved it. I loved it. What did you love about it? Well, so at the time I was living in LA and our neighborhood had a really like a steep hill. And so if I put it on and I walked up the hill, I had the same cardiovascular impact that I did as if I was running a sprint on a track. Yeah. So, but I didn't have the joint jamming and I got the high and I got all of it. So then, then I was addicted. So I am so glad you said that because the data are, you know, come on, the data on whether it builds bone density or kind of plus minus really small. It's a big in the, it's really big in the menopause circles. And I'm never going to encourage women not to do it if it makes them feel like they're achieving something. But if it's the end of all and cure all weighted vest, maybe they increase your bone density one to 3% consistently. But you know why I like it? Yeah, tell me. So I have a 20 pound weighted vest. Exactly what you found. I can get the same work out at less intensity. My heart rate goes, it's about 10 extra beats per minute with this. Yeah. With this, I wear a full vest, 10 extra beats per minute. I'm feeling all like badassery because I'm wearing this vest. But you know what the vest I have, I wear a rucksack vest. It has these little ties on the side. It does something to my nervous system. Oh, oh, it's like a hug. It's like, it's like, you know, you're upset. Okay, hug from behind calming my nervous. I don't know if that's real. Yes. It's what I feel. That's all. It's a calming of my nervous system now. It's, I'm so happy you said that because I thought the same thing. I came back and I was like, I am so happy and so calm and I don't know what's going on. And I thought, it reminded me when my kids were in kindergarten, I remember there was a kid that was, would act up in the class all the time. Well, actually what the mom did is she brought in a bunch of weighted frogs, like those like, like frogs, like stuffy frogs, but they were heavy, like a beanbag. And it was a parent participation class. And she said, if Joey acts up, put a frog on his shoulder. And I remember at the time thinking that really, like that's really going to help Joey in his, in his tantrum. And then one day I was in class and Joey acted up and I pulled a frog out and I put it on his back. And sure enough, he quieted. And then I started putting frogs on my, these weighted frogs on my kids and on the, I'm like, let's calm everybody down. And so when I put the rucking vest on, I thought the same thing. It's like a weighted blanket. It's like a, and at a time when our nervous system is so frazzled, it gives you that added sense of security. Yes. You know what? One day I was just wearing it around the house, cleaning the house. Oh, my daughter's like, oh, you're wearing your vest. I'm like, it just does something to calm me. That is amazing. There's somebody, somebody needs to come up with like a funny meme where like a menopausal woman is like highly agitated. And then she puts a wreck, a rocking vest on is like, yeah. I don't think it gets enough credit for that. And, and I went back to go look at the evolutionary explanation for why rucking might be helpful to menopausal women. And if you go and you look at like, you know, people like Kristen Hawks, who's the champion of the grandmother hypothesis and has studied the Hadza tribe, what they grand, the post menopausal women do in the Hadza tribe is they go for a walk every day to go forage for food, but they take the kids like the toddlers, like the four and five year olds that couldn't go out and hunt and aren't really staying at home with the women who are nursing and pregnant and they would put them on their back and they would walk with them. Yeah. They're talking, I mean, when you study the grandmother hypothesis, you realize that we are fitness wise, not meant to perish. We're actually meant to be even better than ever. But it's, and then she would get a bunch of tubers. She would put them on her head. So she was constantly waiting herself, which is an evolutionary design. Interesting. It makes sense. You know, it really makes sense. And it makes, I just, you made me think I have this gorgeous 40 pound grandson. Put them on your back. Put them on my back. I lift them up to the swing set. So it makes so much sense, doesn't it? Yeah. Yeah. He's, he can go, he can be your strength training and then you're getting oxytocin with him. Like the whole thing is amazing. Okay. Anything else we need to know about? Yeah. Okay. Please tell me. Yeah. Please tell me. Yeah. So let's pull it out. So when I prescribed exercise to mid-life people, we talked about the acronym I use as face. Again, I find people like, Yeah, it's great. F is flexibility and joint mobility. I know this will ring with you because we have to keep our tendons and ligaments long. And we have to keep our joints moving through a full range of motion. Otherwise they get dried out, all rusted out, and we become the hunched over shuffling people. So that's F. A is aerobics. E is carrying a load. We talked about, but E, we've got to spend time. On equilibrium and foot speed. I physically teach the women that come to here to be with me physically. Foot speed. I have this, I have this Olympic track and field speed coach here in this place where I work. We teach our women the same methods that we teach Olympic athletes to move our feet fast. And why do we need to do that? So when we're trying to trip, we don't fall down. We have enough foot speed to get over the bag that I trip on nearly every day by my desk, or not to fall on the curb so that we do not have the fatal fall. Yeah. We're alive and well. We trip over something. Yeah. We break our hip and we have a 30% chance of dying in one year. It's foot speed. It's balance. So what is that? That just happened to my 85-year-old mom. She fell over on a box and osteoporotic fractured her shoulder, had to have reverse shoulder surgery. Your parents can be really good models of what you don't want to age like. And I thought about that. Her balance can be really off. So what does foot speed look like? Like, is it, do I need to take up salsa dancing? Or can I do it? Salsa is a very good way to work on all of this, including your brain. Salsa, pickle. But foot speed looks like, imagine sitting on a box, sitting on a plio box, and just on the ground going like this real fast. Oh, just like, we call it, you know, I used to do P90X forever. And he called it football sprints. Exactly. Agility. Or sometimes we use hexagons and we just go foot out, foot in, foot in. Oh, yeah. You know what I'm going to introduce back? I just made a reel about this. I am going to introduce hopscotch back to this. Oh, hopscotch is so fun! It's jumping, it's lateral motion. Yes. And it's play. Play is so good for us. Yes. I want to, when I post that, I want to see you hopscotch-ing. Because you're all in. Yes. Oh my God. And then you get to act like a kid, which is going to now bring in like dopamine and seratune. And so wait, but you could do even more. Like you could do everything on the play yard was great. So we had hopscotch and then we had monkey bars. Have you ever tried doing the monkey bars as an adult? It's cool. Yes, because it's part and race and it's very hard. Okay. It's very hard. But that's grip strength. That's upper body strength. Yeah. I'm not going to be a rope, but I can do the rings. Yeah. And what about jump rope? Would jump rope be good? Jump rope. Yeah. Good for foot speed and jumping because for those of you listeners that don't know, bone builds when we translate biomechanical impact, literally bashing your bones to biochemical signals that, oh, we need to build some bone osteoblasts, jump roping, jumping up and down, plyo boxes. A mini tramp can work. NASA uses mini tramps. If your knees are killing you, get in a pool and jump in a pool. Right? And I'll take anything to build your bones. But four times body weight jumping is what the papers say that jumping. Interesting. Yeah. So what about vibration plates? Yeah. Like power plates have some research that shows that the small vibrations, I forget the hertz, 50 hertz, can that going up your bones can stimulate the osteoblast to build bone. And so if we, I love your acronym of face. So if we follow the face strategy that we, if we, is that what we, I was going to say, face ourselves, face ourselves. Is that a recipe not just for keeping your posture strong and your moods good, but is it a recipe for preventing osteoporosis? Impact in the form of cardio can prevent osteoporosis. Lifting definitely, we can increase our bone density up to 13% a year by a consistent heavy lifting program because of the, again, the mechanical pull on bones. And then the way equilibrium and foot speed works is to prevent the fatal fall. So all the face is how I encompass all the, all the types of mobility that we need in midlife. Cause listen, when I was 20, I got away with cardio and I didn't lift that much, but like you did, my balance was good. My flexibility was good, but now we need to pay attention to those four things. Yeah. I think, I think that's so beautiful. Okay. I want to come back to collagen and creatine because I do know the connection that as estrogen goes down, those two go down as well. All right. You, you had mentioned you cut my sense in what you said before is you're not a huge supplement fan. Is that, did I misread you? I have a short stack. I don't have 62 things. Excellent. Tell me. I have a short stack. We must have enough calcium, but I prefer calcium be taken in food. I prefer such as such as, believe it or not, salmon poached with the bones. Mmm. Like in a can, like fresh, fresh canned salmon or sardines, mushrooms, prunes and figs, all dairy. I mean, when you add those up, you can get 18 mill, 1800 milligrams of calcium pretty well. If you're eating, amazing. Yeah. Supplement vitamin D three, obviously magnesium, 500 milligrams in the form of L three and eight or glycinate, not citrate people unless you want diarrhea. Cause that's what we give in the hospital to relieve. Listen, yeah. Magnesium citrate, a little green bottle does the trick creatine. I take 10 grams of creatine a day. Five is what we started with. And then that paper recently came out with Alzheimer's cognitive function with 20. So I'm like, okay, I'll just up it to 10. Yeah. So 10 of creatine, really good, really good research with muscle and brain. What else? Lots of protein. I take a few longevity type supplements. I don't take the whole stack that people can. I take a form of NMN so that my body will build an AD plus. Measure my intracellular and AD plus with a, there's a, there's a lab called Ginfinity owned by a science of my scientists, a friend of mine. So that I also take phycetin because I am really interested in senescent cells, increasing the load of senescent cells, which for your listeners are those cells, which are neither living nor dying. They're just too damaged to die. So they're spewing out all kinds of cytokines. So phycetin comes from berries, strawberries. You can't get enough by eating strawberries, but a lab out of veil led by Johnny Huard has done tons of research showing we can do the senescent cell load with these. Beautiful. Yeah. These simple supplements. Thinking what else I, I'm, I'm, I'm visualizing my. Are you, yeah. Are you a big fan of account? You're, you're like, do I need to get 30 grams at every single meal? Or are you just like, Hey, just eat protein. Well, eat protein. I'm a big fan of a gram per pound. Here's why. Here's why. I can support with research up to 0.73 to 0.86 grams per pound. But I'm a clinician and I'm telling you, nobody's doing that math. Right. Yes. Thank you. Yeah. Nobody's doing it. And number two, we don't absorb it all. Yes. So, so, but I think we need enough protein. I find most women are under-proteined. They eat a salad with nothing dressing soup. I call it dressing soup. I don't want you to put the box in the lettuce is all. I love that. Would you, would you, what would you say to a vegetarian? You know what? Here's what I say to you. Think about bowls. Bow vines are completely made of muscle. It is possible to build muscle eating only vegetables. You just have to eat all the frigging time. Right. Right. Oh, yeah. So many calories. Three and a half cups of northern white beans to get the same protein and a little cup of yogurt. It can be done. Number one, that being said, you have to be mindful of your essential amino acids. You're probably not going to get the branched genes, the other six amino, there's nine essential amino acids, but you know, you know this. You got to be very careful if you're only eating plants. Yeah. Yeah. You have to be really intentional. Yeah. That's what I, that is all. I mean, I, I was a vegetarian in my 20s. Yeah. And I was, I was, I was, I was injured all the time. I was a competitive athlete. I gained a bunch of weight because I was just doing carbs all the time. And I didn't, it took me a long time because I had read a diet for a new America by John Robbins. And I was like, Oh my God, we're hurting the animals. And so then I decided, and then I just became sicker and sicker until about 25. I was like, I'm done. I need to go back to eating meat and things, things got a lot better. So, but I have a lot of empathy for people who are like, well, I don't want to eat animals. I, and I, and, and we do need plants. We need to eat plants. But at the end of the day, I think if you're looking at muscle in general, it needs a lot of protein and it's hard to get. Yeah. So, and do you think osteoporosis is preventable? So here's my take on it. The short answer is yes, but it doesn't start in midlife. We lay down maximum bone density between about 15 and 25. Some will extend it to 30. I do bone densities on everybody, either by dexa scans or REMS, which is ultrasound. And I have 22 year olds and 30 year olds with terrible bone density. So either we, so number one, we can prevent it if we lay down enough bone initially and get a high peak bone mass. But then we don't because we are taught to be small and not eat or maybe we are athletes and we're not refeeding enough. So we, we're not having periods for nine months. I used to not have periods for months because I was an LA dancer and a while. Oh yeah. That's the worst. That's the worst. And then so we need to lay down bone to prevent then what happens when we're making babies? We take 500 milligrams of calcium from our bones a day to make a baby. And now your program to rebuild that. But only if we're eating well enough, only if we have time to rebuild and don't have a baby every year for so that's the motherhood loss of calcium. And then at 45, we start losing our estrogen. There is a normal aging decline in bone density that happens in men and women. But for women without the stimulation of estrogen, which balances bone breakdown and bone. We precipitously will lose 15 to 20%. So that's why Mindy, I want people to start in the critical decade. So smart. Because to prevent osteoporosis in women who have already lost 20% Rolling a boulder up a hill. It's much harder than knowing it's going to happen. Getting in front of it, putting all the things in place. And never losing it in the first place. Now, if you have lost it, like if you're osteopenic, your your T score is down to below minus one, but not yet osteoporotic. You can rebuild that. We jump, we eat protein. We lift weights heavy. We do all the things. You can reverse osteopenia. And then osteoporosis. Yeah, you have to think about whether you want to use medications. Yeah, it's interesting because my 85 year old mom has had two hip replacements, a shoulder replacement. Yeah, she's bionic and she's osteoporotic. And so my sister, my sister's in like 58. We spend a lot of time like talking about how do we not end up like mom? And so it is interesting. I love this idea of doing it early, even though I'm out of that critical period. I do. I just am curious. I mean, for me, the rocking, one of the things that inspired me was what I had seen in the research on rocking and osteoporosis. I don't want to give your people the thought that it's too late ever. It's not too late. Your body will always respond, always. You know, even my mother's 86 and she's building muscle. You know, that's amazing. That's amazing. You need to do real with her. Oh, she's amazing. Yeah. What about hip replacement? Do you think, I mean, that's a pretty in vogue surgery right now. Is it is it preventable? So listen, I think I've already said that arthritis rapidly progresses in women over 50 because of the loss of estrogen. It's preventable if we get in front of the estrogen problem. It's preventable if we don't develop the arthritis that comes by carrying around an extra 50 or 100 pounds. Hmm. Right. Interesting. Because cartilage is very sensitive to load. In fact, in our cartilage lab at I was at the University of Pittsburgh, we used to kill cartilage by just dropping a weight on it. Right. It's very sensitive. That sense it's preventable. But in my career lifetime, the attitude on total joints has changed completely. Oh, yeah. We used to wait until the last minute, get it, get it at the last very minute, suffer for 20 years, lose all your muscle mass because you only get one set. Now we know that by sentencing people to sitting around for 20 years until they're old enough, we're sentencing them to sedentary death syndrome. So I am much more apt to send a 50 year old who have destroyed their knees due to trauma or sports or something like football to get knee replacements. Knowing that we might have to revise them in 20 years, given him or her 20 years of active life. Does that make sense? Yeah. Oh, yeah. Yeah. I've totally changed my opinion on joint replacement after just having so many people in my life go through it and watching them and going, wait, that really looks like it kind of worked. So yeah. So you're right. The technology has changed. Where do you think HRT fits into the musculoskeletal profile of a menopausal woman? Like, would you sit with every 40 year old and just say yes, you have to get on HRT? Like, is it a must in order from a musculoskeletal lens? So my statement is every woman is a sentient being with agency to decide. I insist. Yes. I insist, however, your decision be made based on facts, not fear, not fear of the WHI, but the facts of what we know from reanalysis of data. That's where I stand on that. That being said, every musculoskeletal tissue has estrogen receptors. So if I want to maintain muscle and bone and tendon and ligament and cartilage, I want enough of it around. And I'm going to tell you for sure, Mindy. In my patients and in my own life, the minute or the month that I started with hormone optimization, my arthralgia went away. My body didn't hurt anymore and I could get out of bed. And for the women out there that suffer from frozen shoulder, which is like just everybody, inflammation of the shoulder capsule, as a critical part of decreasing that inflammation that just takes over your shoulder joint. So is it mandatory? Hormones are never mandatory. Do I demand people make the decision based on facts and make an intelligent decision? Yeah. And if you decide that you just want no part of it, like 90% of women do, well, that's your decision. There are consequences to every decision that you make with agency. Yeah, that's really well said. One of the ways I always explain it is that it's definitely a personal choice, but it doesn't give you a free pass from lifestyle changes. I think a lot of women were like, oh, okay, well, I can just stop suffering and eating my Big Mac and skimping on sleep and not working out and I'll rub some cream on me and I'll be fine. And I think hopefully as a collective world, we're starting to see that different. Yeah, it's not one thing. It takes an ecosystem. Yeah. Yeah. So dream with me as we finish this up. Dream with me for a moment. If people hear conversations like this, they read your book, they start to approach menopause from such a different angle than our mothers did and our grandmothers did. What the piece that I haven't visually been able to master in my mind is where do you think we'll be at 80? What do you think 80 will look like aging if we follow your formula? 80 will be we get to do what we want to do when we want to do it without having to ask somebody to help us unless we want to. That's my 80, 97, whatever I live to goal. I may choose to ask for help, but I don't want to have to. Beautiful. That's beautiful. How long do you think I just have to add this extra thing? How long do you think the musculoskeletal system can thrive? Like the human body, they say is you can live to 120. If you follow regiments like what you're teaching, do you think you can physically thrive well into your hundreds? I think so as long as you haven't traumatized your joints as a young person. I was a football doctor. I had very young men with very old knees from the trauma. So if you do constant maintenance, we're reinvesting, we're feeding this vessel, I think our bodies are meant to last. Yeah, I love that. And I think that, I mean, that is the message that needs to get out because we need to repattern in our brains how we've seen aging and the only model, visual model we have right now is our mothers. And then we of course have our grandmothers, but there's this whole new wave of aging that's coming. And I think we need more to point out more and more about just how the body was built to thrive, even into our hundreds. So I'm going to tell you for sure that has been the guiding light of my career to change the way we age in this country. I just love that. Well, I'm excited for your book. How do people get it? Where do they go buy it? It's available everywhere now for sale. There's a website, TheUnbreakableBook.com. So it is all the goodies on it. The Unbreakable Book. I hope everybody loves it. Yeah, it is a great name. When I first saw it come through my socials, I was like, ooh, that's a good name for a book. So well done on that. And we'll leave links for everybody. And what I have to ask you, what's your favorite chapter? Do you have a favorite chapter or section of the book? I like the stories I tell throughout. But you know what? I love, I just got done recording it on audiobook. I really love. There's one chapter that's all about this conversation. It pulls everything about aging into the menopause conversation. Amazing. Amazing. I love that chapter. Well, I can't wait to read it. And I'm just so happy that you're bringing your information out. I think it's so easy as doctors for us to just get stuck in our little clinics. And the benefit of social media and books is that you get your knowledge, but they aren't necessarily in your clinic. So. Well, thank you so much. Yeah. Yeah. Thank you. I've really enjoyed this and good luck. Good luck with the book and everybody go get it. We should all be, we should have like one bookcase that just has all the menopausal books. Yeah. Because you can't have too many. So yeah. Thank you. So thank you. Cheering you on, Vonda. Thank you for this conversation. My pleasure. Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it. So please leave us a review, share it with your friends, and let me know what your biggest takeaway is.